Lower back pain is one of the most common conditions in the US, with about 65 million Americans having recently experienced¹ it. Additionally, about 16 million adults (8% of the population²) experience persistent, long-term lower back pain.
More notably, more than 80% of Americans will experience lower back pain³ at some point in their lives. This is an alarming fact, considering that most cases of back pain are preventable.
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The spine is one of the most important structures in the body. It helps support our whole body and provides a strong base for our day-to-day activities. It is strong, but certain activities can increase the risk of injury.
Typical ways to hurt your back include being in bad postures and performing repetitive movements. Here is an overview of each of the three motions that may lead to lower back pain:
Twisting your back is an everyday movement that is almost unavoidable. You twist your back all the time, such as when you turn to shut the door or retrieve grocery bags from the car. It is generally a harmless movement, but there are times when it can lead to back pain.
How twisting hurts back muscles
Twisting requires the stretching of your back muscles and ligaments to accommodate movement. Overstretching or heavy twisting motions can cause muscle spasms, overstretched ligaments, and spinal injuries.
Ongoing inflammation and muscle tightness can persist for extended periods, especially if you continue to perform twisting movements repeatedly.
Some everyday activities that involve twisting your back include:
Playing sports (e.g., tennis, hockey, etc.)
Picking up and moving heavy items
Stretching your back when sitting, bending, or kneeling
Doing household chores such as vacuuming
Lower back pain when twisting can be mild or severe, depending on the injuries' extent. Muscle spasms can persist for long periods if you haven’t rested or looked after your back.
Arching the lower back backward can sometimes be harmful, and those with disk problems, such as spondylolisthesis and degenerative joints, should be especially wary.
However, arching can be healthy for your back⁴ if done correctly.
The human spine is naturally arched (curved) at two points: the lumbar (lower back) and cervical (neck) areas. Another name for these arches is lordosis.
Lordosis is essential for the spine's flexibility and ability to support movements, such as standing, sitting, and walking.
Arching your back involves exaggerating the natural arches of the lumbar spine (lower back). This occurs as you push your belly button forward and chest higher — a movement also known as lumbar extension or lordosis.
While not as common as twisting, below are several activities or factors which may lead to this motion:
Wearing high-heeled shoes for long periods
Having weak core muscles or hip muscles
Suffering from a spinal condition
Suffering from neuromuscular diseases, such as cerebral palsy
It is also worth noting that being inactive can increase the arch (or lordosis) in your lower back. Some exercises that increase lordosis can lead to lower back problems if not monitored carefully. We will discuss examples of these activities below.
Increasing your back’s arch (known as hyperlordosis) affects the spine and the surrounding muscles. Examples include weak hamstrings, pressure in the spinal facet joints, and inactive core muscles.
Whether it’s the arch causing these changes or the change in these structures leading to the arch can vary person-to-person.
Anterior pelvic tilt
The anterior pelvic tilt is one effect of hyperlordosis (increased arch in your lower back). This describes the hip position, which causes the bottom to stick out further and the abdomen to sit more forward.
Over time, this can cause the lower back muscles to shorten and become tighter. Ultimately, this leads to lower back pain and stiffness.
Cracks and fractures
Excessive arching over prolonged periods can also cause cracks and fractures between the joints of your vertebrae (spinal bones). Examples of some conditions include spondylolisthesis or a pars fracture.
Over time, these conditions can cause nerve compression and damage, leading to sciatica, nerve pain, and muscle spasms.
The long-term effects of increased lordosis (arch in your back) can affect your day-to-day movements and livelihood. While safe for some, others may experience worsening lower back pain due to excessive arching.
Arching is harmful to your back only when performed excessively and carelessly over long periods. It can actually benefit those with certain conditions, such as disk bulges and herniations. When sensibly introduced into an exercise program, it can help with muscle relaxation and strengthening.
Heavy lifting is one of the leading causes of lower back pain. Below are three types of injuries that can occur when lifting:
The spine is composed of connecting vertebrae (spinal bones) which have a disk in between to help absorb shock and carry your body’s weight. These disks assist with movement but can become injured during certain activities.
Disk herniation is a common type of spinal disk injury. It occurs when the disk's protective cartilage extends out of place or tears. People living with this condition will have their disk(s) slip out of their usual position.
Nerves can become pinched between the slipped disks, which can cause sciatica, a condition where the sciatic nerve from the spine is being compressed.
Sciatica is characterized by pain in the feet and legs. Other symptoms can also occur, such as burning, pins and needles, numbness, and muscle spasms.
Disk herniation occurs during heavy and repetitive spinal movements, particularly in lumbar flexion. This is the act of bending the spine forward to perform activities, like tying your shoelaces or picking up an object.
Unsurprisingly, it is common among weightlifters and people whose occupation involves lifting heavy objects. For instance, male construction workers are nearly twice as likely⁵ to develop a lower back disorder than all other male workers.
Lifting heavy objects can stress your lower back muscles. Many people who experience lower back pain when lifting heavy objects use improper techniques unknowingly.
Proper lifting techniques involve lifting and pushing with your legs rather than your back.
Placing too much pressure on the back muscles can cause them to pull, spasm, and tear. Eventually, these can lead to conditions that can cause the back to become stiff and painful.
The spine comprises many bones, all connected to the facet joints. Exerting too much pressure on the joints can cause damage and pain.
Examples of joint problems include:
Facet joint dysfunction, which affects the connections at the back of each disk
Sacroiliac joint dysfunction, which affects the joints connecting both sides of the pelvis to the sacrum (tailbone) found below the lumbar spine (lower back)
The joints are held together by strong ligaments supported by the muscles around them. However, repetitive and/or traumatic activities can cause these strong structures to tear and stretch.
The positive side of lifting
Lifting is not entirely bad. Working your back muscles can help strengthen your movement, which is healthy for your back and spine. Gentle stretching after lifting can also help relieve tight back muscles and reduce stress.
Lifting can be beneficial for your back only when done correctly. Here are four tips to help you avoid the dangers of heavy lifting:
Don't lift more weight than you can handle
Use your leg muscles to lift (not your back muscles)
Lift slowly and in a controlled posture
Keep the object as close to you as possible
Ideally, your back muscles shouldn't feel strained after lifting — the pressure builds up over time and causes the effects described earlier. It is recommended to consult a strength coach or physiotherapist if you are concerned about your lifting technique.
Understanding the cause of your lower back pain is essential for several reasons. The most obvious benefit is getting a diagnosis early, so you can treat it quickly before it gets worse.
Your doctor may recommend a range of tests to determine the cause of your lower back pain, including:
MRI and CT scans of the spine and affected areas
Bone scans to look for spinal deformities
Urine and blood tests to check for any underlying conditions
X-rays are used to check the spine's alignment and look for certain conditions. These tests can be uncomfortable, but the trade-off is having a better idea of what may be the source of your lower back pain.
Understanding the cause of your lower back pain will also help you find an efficient management or treatment plan. For example, lower back pain caused by degenerative changes requires a different treatment approach compared to disk or disk problems.
Many people experiencing lower back pain ignore it until it becomes too much to bear. This is not ideal, as an early diagnosis can help your doctor develop more efficient management and treatment plans.
It is important to see a doctor as soon as you realize that your lower back pain is not improving (or if it doesn't subside after a week).
Other signs and symptoms that warrant a trip to the doctor include:
Lower back pain that extends to the buttocks, legs, and other regions around the body
Pain combined with a burning or tingling sensation in your feet and legs
The pain is affecting your bowel movement
The pain makes it difficult to walk or make other postures, such as bending down to sit
Remember to be honest about any risk factors that may have contributed to your lower back pain. Once you have discussed your options with your doctor, make sure to follow their recommended treatment and management plans.
The three movements and motions discussed are among the most prevalent risk factors for lower back pain.
Lower back pain from these movements can be gradual, so be mindful when twisting, arching, lifting heavy objects, and any other repetitive or vigorous back movements.
If you have persisting lower back pain, make sure to see your doctor for a diagnosis and treatment plan.
Chronic back pain | Health Policy Institute
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Low back pain (2003 - PDF)
National occupational research agenda | Centers for Disease Control and Prevention